NPIMap

Organization Active NPI

Robert L Bruckstein MD PC

  • Dermatology Physician
  • Lawrence, NY
National Provider Identifier
1194002733
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
117212-1 Issued in NY
Legal business name
ROBERT L BRUCKSTEIN MD PC
Practice address
290 Central Ave
Suite 206
Lawrence, NY 11559-8507
Phone
(516) 239-2332
NPI assigned
Nov 10, 2011
Last updated
Nov 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert L Bruckstein, MDNPI 1386644375
Title
President
Phone
(516) 239-2332

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 117212-1 NY Primary

Addresses

Primary practice location

290 Central Ave
Suite 206
Lawrence, NY 11559-8507

Mailing address

290 Central Ave
Suite 206
Lawrence, NY 11559-8507
Phone (516) 239-2332

Other identifiers 1

IdentifierTypeStateIssuer
00216904MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120127000790 NY Part B Supplier - Clinic/Group Practice 8022275320 Receives reassigned benefits from 1 practitioner
Practice locations: Woodmere, NY

National Provider Directory

National Provider Directory

Locations

290 Central Ave
Ste 206
Lawrence, NY 11559
Phone (516) 239-2332

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1194002733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 CENTRAL AVE",
            "address_2": "SUITE 206",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115598507",
            "telephone_number": "516-239-2332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 CENTRAL AVE",
            "address_2": "SUITE 206",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115598507",
            "telephone_number": "516-239-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT L BRUCKSTEIN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "BRUCKSTEIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-239-2332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "117212-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00216904",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.